Infections due to non-O1/O139 Vibrio cholerae
- J Glenn Morris, Jr, MD, MPHTM
J Glenn Morris, Jr, MD, MPHTM
- Professor of Medicine
- Director, Emerging Pathogens Institute
- University of Florida
Vibrio cholerae is a highly diverse species, with a worldwide distribution in estuarine environments. Only a small subset of V. cholerae strains carry the requisite genes to cause the disease cholera. In an effort to identify cholera-causing strains, investigators studying the "cholera bacillus" (V. cholerae) in the early 1900s divided strains into two groups: those that agglutinated with serum from cholera patients (designated as being in O group 1, or V. cholerae O1), and those that did not . This latter strain group (most of which consisted of environmental isolates) has been designated, variously, as "non-cholera Vibrios", "non-agglutinating V. cholerae" (also referred to as "NAGs"), or "non-O1 V. cholerae".
Subsequent serologic studies have resulted in the identification of over 200 different O groups within the species V. cholerae. While it is now recognized that serotype does not correlate directly with the ability to cause the disease cholera, use of these serologic designations continues to be useful with almost all cholera-causing strains falling into O group 1 or the recently recognized O group 139 . However, cholera toxin-producing strains of V. cholerae in other serogroups have also been implicated as the cause of outbreaks of cholera-like illness (O141 and O75 in the United States; O37, O10, O12, O6, and O14 strains from other parts of the world) [3-8]. In phylogenetic studies, all cholera-associated strains tend to cluster closely together, consistent with the concept that there is an "epidemic genotype" that includes multiple genes necessary for epidemic disease [9-11].
In general, strains outside of these serogroups (commonly referred to as "non-O1/non-O139 V. cholerae") are non-pathogenic or asymptomatic colonizers in humans, or cause mild, sporadic illness (such a gastroenteritis, wound or ear infections) in otherwise health hosts. However, in persons who are immunocompromised or who have underlying liver disease, non-O1/non-O139 V. cholerae strains are capable of causing severe wound infections or sepsis, with high associated mortality rates.
Non-O1/non-O139 V. cholerae strains tend to be highly diverse genetically, and there is not a single route by which they cause human disease. Occurrence of illness is dependent on the particular combination of possible virulence genes carried by the infecting strain, combined with the health status of the host.
Gastroenteritis — A small number of non-O1/non-O139 V. cholerae strains carry the genes for and produce cholera toxin (CT), the toxin responsible for the dehydrating diarrhea characteristically seen in epidemic cholera [3,12,13]. These strains have been associated with gastroenteritis (which, at times, may be severe) but do not appear capable of causing epidemic cholera. In phylogenetic studies, they do not cluster with V. cholerae strains responsible for epidemic disease and generally lack multiple genes/gene complexes that have been associated with "typical" cholera.
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